Treatment of Diabetes – Oral Agents

Question 1

Intensive glucose control has been shown to reduce _________________.

Answer 1

microvascular disorders and all-cause mortality

Question 2

Recombinant human insulin was first approved by the FDA in ________.

Answer 2

1982

Question 3

What diabetes drug is an alpha glucosidase inhibitor?

Answer 3

Acarbose

Question 4

For type 2 diabetes, the first therapy recommended –and the cornerstone of all therapies –is _________.

Answer 4

lifestyle modifications (weight loss; lower calorie intake; more complex carbohydrates)

Question 5

True or false: biguanide increases the release of insulin.

Answer 5

False. Biguanide (brand name Metformin) enhances insulin’s ability to suppress hepatic glucose release.

Question 6

Recently, guidelines have recommended that doctors assess ________ before prescribing Metformin to patients.

Answer 6

GFR

Question 7

What are the pros and cons of Metformin use?

Answer 7

Pros:

• it doesn’t cause weight gain
• it can be used with other diabetes medications
• it doesn’t carry a risk of hypoglycemia
• it is inexpensive

Cons:

• it can cause GI side effects
• it carries a risk of lactic acidosis (particularly with concomitant imaging contrast, CHF, renal insufficiency, or liver disease)

Question 8

After trying lifestyle modifications, give _________ to those with T2DM.

Answer 8

Metformin

Question 9

Which two oral medications can lower A1c by the maximum amount?

Answer 9

Metformin and the sulfonylureas (both of which can lower A1c by 1-2%

Question 10

GLP-1 is made by the _______________.

Answer 10

L cells in the distal ileum

Question 11

GIP (gastric inhibitory peptide) is made by ____________.

Answer 11

the K cells in the duodenum

Question 12

GLP-1 and GIP are secreted in response to ____________.

Answer 12

food intake

Question 13

What is the incretin effect?

Answer 13

Consuming food by mouth leads to a greater release of endogenous insulin than does raising blood glucose levels to the same amount.

Question 14

Those with __________ have a decreased incretin effect.

Answer 14

T2DM

Question 15

In addition to stimulating insulin release, the incretins also ____________.

Answer 15

decrease glucagon release

Question 16

GLP-1 decreases hepatic release of glucose via two mechanisms: ______________.

Answer 16

decreasing release of glucagon and increasing release of insulin (which also decreases gluconeogenesis by the liver)

Question 17

True or false: the GLP-1 analogues can be given orally.

Answer 17

False. The DPP-4 inhibitors, however, are oral.

Question 18

What does SGLT-2 stand for?

Answer 18

Sodium-GLucose co-Transporter 2

Question 19

The -gliflozin drugs work by what mechanism?

Answer 19

They inhibit the SGLT-2 channels, thereby preventing glucose reuptake in the proximal convoluted tubules of the kidney.

Question 20

The maximum glucose concentration at which SGLT-2 can re-absorb in the PCT is __________; the -gliflozins bring this down to __________.

Answer 20

180 mg/dL; 90 mg/dL

Question 21

What side effects do the SGLT-2 inhibitors drugs cause?

Answer 21

• Increased risk for UTIs (from the excess urinary glucose)
• Risk for hypokalemia (be sure to correct this in the PDF/PP, because she said she accidentally wrote hyperkalemia)
• Hypotension (because of osmotic diuresis)

Question 22

What side effects come with use of sulfonylureas?

Answer 22

• Hypoglycemia
• Weight gain
• Loss of effectiveness due to increased insulin resistance

Question 23

Which two non-insulin drugs should you NEVER co-administer?

Answer 23

GLP-1 analogues and DPP-4 inhibitors

Question 24

Which three non-insulin drugs are best for patients with ASCVD?

Answer 24

Metformin
GLP-1 agonists
SGLT-2 inhibitors

Question 25

Go straight to insulin in type 2 diabetics with _____________.

Answer 25

impaired renal or hepatic function

Question 26

The shortest-acting sulfonylurea is ___________.

Answer 26

glipizide

Question 27

What are three contraindications for sulfonylurea?

Answer 27

Liver disease, renal failure, or G6PD deficiency

Question 28

The FDA now recommends obtaining ___________ prior to prescribing metformin.

Answer 28

the patient’s eGFR

Question 29

Use of ___________ has been associated with bladder cancer.

Answer 29

thiazolidinediones

Question 30

True or false: GLP-1 secretion by L cells in the distal ileum occurs roughly an hour after food has been ingested.

Answer 30

False. It occurs within minutes.

Question 31

Why is there no pharmacologic analogue of GIP?

Answer 31

Because those with type 2 diabetes are generally resistant to the effects of GIP

Question 32

The two main effects of using GLP-1 analogues are ____________.

Answer 32

lowered A1c and weight loss

Question 33

What is the main advantage of DPP-4 use over GLP-1 analogue use?

Answer 33

DPP-4 are oral!

Question 34

Pramlintide was developed because amylin ______________.

Answer 34

has a tendency to form amyloid deposits

Question 35

The main effects of pramlintide are _______________-.

Answer 35

delayed gastric emptying and decreased postprandial glucagon secretion

Question 36

You know that metformin and GLP-1RAs can help with weight loss, but there is another non-insulin diabetes medication that can, too. What is it?

Answer 36

SGLT-2

Question 37

The least potent drug (in terms of A1c lowering ability) is ____________.

Answer 37

DPP-4 inhibitors

Question 38

what two drugs lower cardiovascular events

Answer 38

SGLT2 inhibitors and GLp-1 agonists

Question 39

indications for SGLT2

Answer 39

reduce CV risks
prevent heart failure hospitalization
reduce BP
oral administration

Question 40

Indications for GLP-1 agonist

Answer 40

reduce CV risk
weight loss
once weekly subcutaneous dosing